I began experimenting with EMR in the early ‘90’s, creating a voice dictation system for our pediatric department using Dragon Dictate and Word. We did that for about 5 years, with multiple languages present in the doctors. It worked fairly well for readability but not for speed. We, along with many other early adopters, found that using computers for medical systems just lost family time in exchange for legibility. The hardware and software was just too slow. I did transcription for about 10 years, awaiting hardware that was up to the task of what we do in medicine—manage immense amounts of data about patients and proceed with a care plan dictated by physiology and development. In 2005, with our paper charts with a chronic mis-filed rate of about 15% no matter how many folks we hired, we began our search for another way to record information about our patients. My experience before led me away from inadequate, note-taking only solutions. We knew we needed a more comprehensive answer, a system that organized our care of patients and the office flow, allowed multiple folks to work on a chart at once, and eventually, CPOE became a requirement, winnowing the field immensely. We chose EncounterPro out of Atlanta GA, and haven’t looked around since, because we found software that could mirror our workflow and was adaptable as we grew and changed. We have had periods of hard work but these have been interrupted by episodes of delight—finding out that the software could take care of a problem we had previously thought was impossible to address. All hasn’t been totally wonderful, but we all agree that we would never want to go back to paper. No regrets.
We could read everything! This saved transcription costs immediately. No more lost charts. We saw the same number of patients within 4 weeks as before implementation. We began rethinking how we see patients without paper in the way—with its shuffling, bulk and legibility issues. The EHR gave us new eyes to see problems that were integral to paper charting, and allowed to see if this method worked better in seeing patients. Often, we saw that our desired solution was either already programmed and we just had to find it, or it was possible if we just modified the way we did the work. We also learned to talk to one another about common solutions. Using the computer led us to find one best process for the office. We had made many exceptions for each other with paper charts, but that didn’t work well with a process-oriented electronic chart. Most of us spend very little time in our offices; we now use kiosks between our rooms in the hallway, which saves thousands of steps. We get very good shoes, because we stand more.
We know how to code, period. ICD 9 and procedure codes are familiar to us, so our billing is more accurate from the outset. Our office administrator feels our rejection/re-file rate is now far less than before. Also, if we need to re-file, we can quickly understand what went on in the visit. We now have access from home and vacation and meetings. Some might say sadly so, but it is a much better way to take care of patients. As a physician, you just don’t know when you might need to know about the last steps taken with a patient, and wherever we are, we can speak intelligently. I think our charts are more useful for those reviewing for legal records or research records. We print out a dated and certified copy and all are happy. Transfer of records is done through a fax server so we don’t print and send records anymore—they are sent directly. We don’t print out school excuses, which were being forged and modified frequently, or not delivered at all. They are sent through the fax server directly to schools. We have had learned this lesson repeatedly; when we give in and give a copy to parents who demand it, it is found to be modified. It is easier to be HIPPA compliant, everyone is password protected for access. We have never been hacked in 5 years that we know of.
Would you like to join an exclusive group of champions? HITArkansas is looking for local and regional health care clinicians who have adopted an EHR system and would like to serve as local leaders, advisors and role models in the move towards an electronically-enabled health care system.
If you are interested and you:
Have made the transition to paperless systems
Have had success using EHRs in patient care
Are experienced with data exchange (e.g. e-prescribing, lab reports)
Are willing to share experiences, help peers and educate patients on EHRs
This is part of a national movement called the Meaningful Use Vanguard (MUV program). Arizona and North Carolina RECs have already identified providers who are leading the way to meaningful use!